Anesthesia Coding Alert

Question: What CPT code should we report for a D&C for blighted ovum?

Wisconsin Subscriber

Answer: Verify the surgical code, but the surgeon probably reported 59820 (Treatment of missed abortion, completed surgically; first trimester). The Crosswalk lists 01964 (Anesthesia for abortion procedures) as the corresponding code, but that doesn't mean it's always the best code.
 
The procedure may not always be a spontaneous abortion procedure, so reporting 01964 may cause unnecessary denials from Medicaid or other carriers. Other denials might come because the situation and necessary surgery happen so quickly that the staff neglects to get the patient's signed consent.
 
Technically, the patient is no longer pregnant at the time of the procedure, so you can code it as a non-obstetrical case. Because of this, some coders recommend 00940 (Anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix or endometrium]; not otherwise specified) instead of 01964. You'll lose one base unit of reimbursement (01964 is a 4-unit procedure, and 00940 is a 3-unit procedure), but reporting 00940 might be the only way to get your anesthesia claim paid while accurately describing the situation.